HOOPER — Lately, Nicky Stauffer has been spending more and more time on the telephone, calling any agency, any clinic, any hospital that she thinks can help in her bid to secure medical care.

So far, the Hooper woman — in need of radiation treatment following breast cancer surgery last March — has batted zero. It weighs on her.

Uninsured, lacking deep pockets and unable to secure Medicaid coverage to help cover the cost of continued care, which could cost $25,000 or more, she worries the cancer will come back and spread. Being a mother, noting an aunt who died of breast cancer at the age of 44, the 36-year-old woman ponders her future, fearing the worst and struggling for a solution. 

“I’m broken. I’m just so defeated,” she said from the living room of her home, seated on a couch beside her husband, Corey Stauffer, a self-employed plumber. “I feel like I’ve put up a good fight and I’m defeated and I don’t know what to do.”

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Nicky James Stauffer talks about her efforts to secure insurance to treat her breast cancer, at her Hooper home on Friday, July 7, 2017. Stauffer, uninsured, has been battling breast cancer since February, but has been unable to secure insurance to keep up the fight and worries about her future.

As U.S. lawmakers debate the future of health care in the country, many, like Stauffer — a stay-at-home mom — are left in the lurch. Her options are limited as she doesn’t qualify for Medicaid, a federal-state health care program for kids, the needy and others, and she’s unable to afford marketplace coverage under the Affordable Care Act, or Obamacare.

Likewise, with President Donald Trump and fellow Republicans in Congress pushing for a new GOP-crafted plan to replace Obamacare, change that could scale back Medicaid funding going forward, good news for her isn’t necessarily in the offing.

As is, an estimated 70,000 to 90,000 in Utah fall into the Medicaid coverage gap, unable to secure health care via Medicaid or the Obamacare marketplace, like Stauffer, according to Micah Vorwaller. He’s a health policy analyst and legislative counsel for the Utah Health Policy Project, a non-profit group that focuses on health care issues.

If new checks on Medicaid funding are implemented by Congress and Trump and guidelines on who qualifies are reined in — possible, though the GOP plan remains subject of intense deliberation — the numbers in the coverage gap could grow, he fears. 

“That would actually give Utah less money than what it would receive if we just stayed status quo,” Vorwaller said.

Even if federal lawmakers take no action or can’t agree on a reform plan, also possible, Stauffer and tens of thousands of others in her situation are hardly free and clear. The coverage gap stems from an earlier decision by Utah lawmakers when the decided to forego the Medicaid expansion envisioned in Obamacare. The plan offered increased federal funding in order to expand the ranks of who qualifies for coverage under the program.

Nationally, the Kaiser Family Foundation estimated last year that 2.5 million people fell into the coverage gap, coming from the 19 states, including Utah, that opted out of the Medicaid expansion.

Corey Stauffer, disappointed on learning Obamacare marketplace premiums would be beyond his means, is skeptical that any plan lawmakers come up with will change things.

“Beyond desperate. I just want my wife to live,” he said. “I have two little boys. I don’t want to raise them by myself.” 

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Cole Stauffer, 3, leans on the couch at his family’s home in Hooper on Friday, July 7, 2017, as his parents, Nicky James and Corey Stauffer, talk about her efforts to secure insurance to treat her breast cancer. Stauffer, uninsured, has been battling breast cancer since February, but has been unable to secure insurance to keep up the fight and worries about her future.

Nicky Stauffer, after exhausting option after option in her search for coverage, is just skeptical. That she’s had such a tough time, she charges, says “if you’re not within the rich, you’re nothing.”

Unable to secure insurance after discovering the lump in her breast last February, she tapped relatives and others for funds to help cover the cost of her initial treatment in March at Davis Hospital in Layton. Though a lawful, permanent, U.S. resident since 1991, she’s originally from England and hasn’t become a U.S. citizen. That’s complicated her efforts to secure Medicaid coverage.

While not discussing Stauffer’s case, Diane Townsend, the business development director at Davis Hospital, said the facility works hard to help those who don’t have coverage.

“Each patient's situation is unique and defined by their individual circumstances and we offer a wide variety of programs to assist patients to get the care they need,” she said in an email. The hospital can offer self-pay discounts, charity care and help in navigating the healthcare bureaucracy.

‘People have died’

Though worried, Stauffer knows it’s even worse for others. She knows of two women who can’t secure coverage to help with the chemotherapy they need, even though their cancer cases are more advanced.

“Obviously people have died in the Medicaid coverage gap,” Vorwaller added.

A 2015 documentary by a pair of University of Utah medical students, “Donut Hole: Life in the Medicaid Coverage Gap,” zeroes in on the topic.

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That notion worries Stauffer, especially being the mother of two young boys and stepmother of two older girls, her husband’s children from an earlier marriage. It pushes her, keeps her on the phone to U.S. lawmakers serving Utah, nonprofit groups that work with cancer patients and more, searching for solutions, rays of sunlight.

“I’m constantly put through to the next person. I’m just given the run-around by everyone,” she said.

One agency offered her a $250 debit card to cover the cost of gas to get to medical appointments. Thing is, she can’t get any appointments in the first place that would necessitate travel.

Also in need of a hysterectomy to help in the battle against her breast cancer, she plans to appeal the decision denying her request for Medicaid coverage. Having lived stretches outside the United States while traveling with her mother and American stepdad, an officer in the U.S. Air Force who completed stints at U.S. military bases overseas, seems to be a sticking point, according to a Medicaid denial paper Stauffer provided.

“I’m getting punished for being a military kid and being dragged all over the world,” she said.

She came to Utah in 2004, visiting a sister, and later met her husband-to-be at an Ogden home where he was doing plumbing work and she was assisting with interior design.

They’ve mulled selling their Hooper home if need be to raise the funds needed for medical care. Corey Stauffer, who’s thus far avoided any catastrophic health issues that would necessitate insurance, has also looked into getting a job that provides coverage. Still, he’d have to wait three months before he could sign up.

More immediately, Nicky Stauffer launched a Go Fund Me page, hoping to generate donations to help cover the cost of getting a private health care plan or coverage on the Obamacare marketplace, which offers subsidies based on applicants’ income level. As of Thursday, she had received around $4,700 in donations toward a goal of $29,000.

“I think it’s sad that people have to try that process in order to try to afford health care,” Vorwaller said.

Corey Stauffer said his wife’s predicament stems from governmental indifference to the plight of working people and those on the lower steps of the economic ladder, like him and his wife.

“All my wife does non-stop is to try to find ways out of this because she doesn’t want to die. I don’t want her to die,” he said.

Contact reporter Tim Vandenack at tvandenack@standard.net, follow him on Twitter at @timvandenack or like him on Facebook at Facebook.com/timvandenackreporter.

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